Fingertip electrosurgical instruments for use in hand-assisted surgery and systems including same

BACKGROUND

1. Technical Field

The present disclosure relates to electrosurgical instruments and, more particularly, to fingertip electrosurgical instruments for use in hand-assisted surgery, such as hand-assisted laparoscopic surgery (HALS), and systems including the same.

2. Discussion of Related Art

Electrosurgical instruments have become widely used by surgeons. Electrosurgery involves application of high-frequency electrical current to a surgical site to cut, ablate, coagulate, cauterize or seal tissue.

The basic purpose of both monopolar and bipolar electrosurgery is to produce heat to achieve the desired tissue/clinical effect. In monopolar electrosurgery, devices use an instrument with a single, active electrode to deliver energy from an electrosurgical generator to tissue, and a patient return electrode (usually a plate positioned on the patient's thigh or back) as the means to complete the electrical circuit between the electrosurgical generator and the patient. In bipolar electrosurgery, the electrosurgical device includes two electrodes that are located in proximity to one another for the application of current between their surfaces. Bipolar electrosurgical current travels from one electrode, through the intervening tissue to the other electrode to complete the electrical circuit.

Bipolar instruments may include end effectors, such as grippers, cutters, forceps, dissectors and the like, which often have a limited range of motion, e.g., due to mechanical design constraints. This limited range of motion may be undesirable to a surgeon working in an area that requires a complex series of movements. In such situations, it may be desirable to use bipolar instruments that facilitate a wide and variable range of motion to allow for complex surgical articulation. The mechanical nature of bipolar instruments may limit the amount of tactile sensory feedback received by the surgeon during a procedure. In certain procedures, it may be useful to have the ability to determine how much pressure to apply to a cutting or coagulation surface.

Surgical techniques and instruments have been developed that allow the surgeon to perform an increasing range of surgical procedures with minimal incisions into the skin and body tissue of the patient. Minimally-invasive surgery has become widely accepted in many medical specialties, often replacing traditional open surgery. Unlike open surgery, in which a long incision is made to expose the area of the body to be operated on, minimally-invasive procedures, such as endoscopy or laparoscopy, are performed through one or more short incisions, with much less trauma to the body. The number of incisions may depend on the type of surgery. It is not uncommon for some abdominal operations, e.g., gallbladder surgery, to be performed through a single incision. Although minimally-invasive techniques vary widely, surgeons generally rely on a lighted camera at the tip of a tube or cannula to send a two-dimensional image of the surgical site to a high-definition monitor, which the surgeon watches throughout the operation. In most patients, the minimally-invasive approach leads to decreased postoperative pain, shorter hospital stay, faster recovery, decreased incidence of wound-related and pulmonary complications, cost savings by reducing post-operative care, and, in some cases, a better overall outcome.

Minimally-invasive surgical procedures are performed throughout the body and generally rely on obtaining access to an internal surgical site through a relatively small pathway, often less than one centimeter in diameter, to the surgical site. One method of providing such a pathway is by inserting a trocar assembly through the skin of the patient. Commonly, to place the trocar cannula, the penetrating tip of the obturator of the trocar is pushed through the skin and underlying tissue until the distal end of the cannula is within the body cavity. Alternatively, some trocar devices have a blunt obturator for placing the cannula through a previously-made incision. Once the trocar has been properly positioned, the obturator is removed and the cannula is then available as a pathway between the surgical site and the exterior of the patient's body through which the surgeon may introduce the various surgical instruments required to perform the desired procedures. Surgical instruments insertable through cannulae include forceps, clamps, scissors, probes, flexible or rigid scopes, staplers and cutting instruments.

In some procedures, a wall of a body cavity is raised by pressurization of the body cavity to provide sufficient working space at the surgical worksite and/or to allow a trocar to penetrate the body cavity without penetrating an organ within the cavity. The process of distending the abdomen wall from the organs enclosed in the abdominal cavity is referred to as insufflation. During a laparoscopic procedure (endoscopy in the abdominal cavity), insufflation is achieved by introducing an insufflation gas, such as carbon dioxide, nitrogen, nitrous oxide, helium, argon, or the like, through a Veress needle or other conduit inserted through the abdominal wall.

Minimally-invasive surgery has become the standard-of-care for certain surgical procedures, but it has not been widely adopted for more complex or delicate procedures for several reasons. Advanced laparoscopic procedures often take much longer than conventional surgery. This partly reflects the limited instrumentation available for advanced laparoscopic surgery, as well as the lack of tactile sensory feedback and the absence of depth perception, which is inherent in viewing a two-dimensional image on a monitor. The loss of the ability to place the hand into the abdomen during laparoscopic surgery may limit the use of laparoscopy for complex abdominal surgery.

Some surgical procedures, e.g., simple to complex intra-abdominal operations, may be appreciably facilitated by the introduction of a hand into the laparoscopic arena. The human hand is capable of performing many functions during surgery that are difficult to reproduce with laparoscopic instruments.

In hand-assisted laparoscopic surgery (HALS), the surgeon inserts a hand through a small incision via a pressurized sleeve into the insufflated region and uses the hand for sensory perception and to assist the laparoscopic instruments directly, while observing the entire procedure on a monitor. Most surgeons insert the non-dominant hand, but the dominant hand may be used. A hand-assisted technique may be useful in a variety of procedures, including minimally-invasive colorectal surgery, splenectomy for splenomegaly, living donor nephrectomy, and procedures considered too complex for a laparoscopic approach. HALS may offer the ability to perform more complex operations more safely by allowing tactile sensory feedback and depth perception, gentle traction and counter-traction on tissues, digital blunt dissection, hemorrhage control and identification of vessels, structures and tissue planes.

Fingertip electrosurgical instruments for use in hand-assisted surgery such as HALS may be useful in a variety of procedures and operations, and may enhance the suitability of laparoscopy for complex abdominal surgery.

SUMMARY

The present disclosure relates to a fingertip-mountable electrosurgical instrument including a monopolar electrode capable of directing energy into tissue, and a holder configured to be operably coupled to the monopolar electrode. The holder is further configured to be operably coupled to an energy source. The holder includes a housing body and one or more attachment members coupled to the housing body. The one or more attachment members are configured to be removeably attachable to a user's finger. The housing body includes a distal end and a proximal end. The monopolar electrode is mechanically coupled to the distal end of the housing body.

The present disclosure also relates to an electrosurgical instrument including a surgical glove, a monopolar electrode capable of directing energy into tissue, and a holder configured to be operably coupled to the monopolar electrode. The holder is also configured to be operably coupled to an energy source. The holder includes a housing body and an attachment member coupled to the housing body. The attachment member is configured to couple the holder to the surgical glove. The monopolar electrode is mechanically coupled to the housing body.

The present disclosure also relates to an electrosurgical system including an energy source and a fingertip-mountable electrosurgical instrument operably coupled to the energy source. The fingertip-mountable electrosurgical instrument includes a monopolar electrode capable of directing energy into tissue and a holder configured to be operably coupleable with the monopolar electrode. The holder is also configured to support the monopolar electrode such that the monopolar electrode extends longitudinally from a distal end of a user's fingertip.

BRIEF DESCRIPTION OF THE DRAWINGS

Objects and features of the presently disclosed fingertip electrosurgical instruments for use in hand-assisted surgery and systems including the same will become apparent to those of ordinary skill in the art when descriptions of various embodiments thereof are read with reference to the accompanying drawings, of which:

<figref idref="DRAWINGS">FIG. 1</figref> is a perspective view of a fingertip, monopolar electrosurgical instrument, with parts separated, according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 2A</figref> is a schematic illustration of the attachment member of the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 1</figref> according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 2B</figref> is a schematic illustration of another embodiment of an attachment member of a fingertip, monopolar electrosurgical instrument in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 2C</figref> is a schematic illustration of yet another embodiment of an attachment member of a fingertip, monopolar electrosurgical instrument in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 2D</figref> is a schematic illustration of still another embodiment of an attachment member of a fingertip, monopolar electrosurgical instrument in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 2E</figref> is a perspective view of the attachment member of <figref idref="DRAWINGS">FIG. 2D</figref> shown with the ring member in a closed configuration according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 3</figref> is a perspective view of the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 1</figref> shown coupled to a surgeon's finger according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 4</figref> is a perspective view of another embodiment of a fingertip, monopolar electrosurgical instrument shown coupled to a surgeon's finger in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 5A</figref> is a schematic illustration of the first attachment member of the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 4</figref> according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 5B</figref> is a schematic illustration of the second attachment member of the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 4</figref> according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 6</figref> is a perspective view of another embodiment of a fingertip, monopolar electrosurgical instrument, with parts separated, in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 7</figref> is a perspective view of the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 6</figref> shown coupled to a surgeon's finger according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 8</figref> is a perspective view of another embodiment of a fingertip, monopolar electrosurgical instrument in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 9</figref> is a perspective view of yet another embodiment of a fingertip, monopolar electrosurgical instrument in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 10</figref> is a perspective view of still another embodiment of a fingertip, monopolar electrosurgical instrument shown coupled to a surgeon's finger in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 11</figref> is a perspective view of a fingertip, monopolar electrosurgical instrument including a surgical glove according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 12</figref> is a perspective view of another embodiment of a fingertip, monopolar electrosurgical instrument including a surgical glove in accordance with the present disclosure;

<figref idref="DRAWINGS">FIG. 13</figref> is a perspective view of a patient in a supine position on an operating table with his abdomen insufflated, showing instrument access provided by two cannulae and hand access through an incision via a pressurized sleeve, and showing the fingertip, monopolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 12</figref> according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 14</figref> is a perspective view of a fingertip, bipolar electrosurgical instrument according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 15</figref> is a perspective view of a fingertip, bipolar electrosurgical instrument including a surgical glove according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 16</figref> is a perspective view of a patient in a supine position on an operating table with his abdomen insufflated, showing instrument access provided by two cannulae and hand access through an incision via a pressurized sleeve, and showing the fingertip, bipolar electrosurgical instrument of <figref idref="DRAWINGS">FIG. 15</figref> according to an embodiment of the present disclosure;

<figref idref="DRAWINGS">FIG. 17</figref> is a perspective view of another embodiment of a fingertip, bipolar electrosurgical instrument in accordance with the present disclosure; and

<figref idref="DRAWINGS">FIG. 18</figref> is a schematic illustration of a visual signal indicator according to an embodiment of the present disclosure.

DETAILED DESCRIPTION

Hereinafter, embodiments of fingertip electrosurgical instruments for use in hand-assisted surgery and systems including the same of the present disclosure are described with reference to the accompanying drawings. Like reference numerals may refer to similar or identical elements throughout the description of the figures. As shown in the drawings and as used in this description, and as is traditional when referring to relative positioning on an object, the term “proximal” refers to that portion of the apparatus, or component thereof, closer to the user and the term “distal” refers to that portion of the apparatus, or component thereof, farther from the user.

This description may use the phrases “in an embodiment,” “in embodiments,” “in some embodiments,” or “in other embodiments,” which may each refer to one or more of the same or different embodiments in accordance with the present disclosure. For the purposes of this description, a phrase in the form “A/B” means A or B. For the purposes of the description, a phrase in the form “A and/or B” means “(A), (B), or (A and B)”. For the purposes of this description, a phrase in the form “at least one of A, B, or C” means “(A), (B), (C), (A and B), (A and C), (B and C), or (A, B and C)”.

Electromagnetic energy is generally classified by increasing energy or decreasing wavelength into radio waves, microwaves, infrared, visible light, ultraviolet, X-rays and gamma-rays. As it is used in this description, “microwave” generally refers to electromagnetic waves in the frequency range of 300 megahertz (MHz) (3×10⁸cycles/second) to 300 gigahertz (GHz) (3×10¹¹cycles/second). As it is used in this description, “ablation procedure” generally refers to any ablation procedure, such as, for example, microwave ablation, radiofrequency (RF) ablation, or microwave or RF ablation-assisted resection. As it is used in this description, “energy applicator” generally refers to any device that can be used to transfer energy from a power generating source, such as a microwave or RF electrosurgical generator, to tissue. As it is used in this description, “transmission line” generally refers to any transmission medium that can be used for the propagation of signals from one point to another. As it is used in this description, “fluid” generally refers to a liquid, a gas or both.

As it is used in this description, “finger” generally refers to the terminating members of the hand including the thumb. In general, the term “finger” is interchangeable, in this disclosure, with the terms “surgeon's finger” and “user's finger”. As it is used in this description, “tip segment” generally refers to that portion of a finger including the distal phalange (also known as the third phalange). As it is used in this description, “middle segment” generally refers to that portion of a finger including the second phalange. As it is used in this description, “base segment” generally refers to that portion of a finger including the proximal phalange (also known as the first phalange). As it is used in this description, “top knuckle” generally refers to the distal interphalangeal joint. As it is used in this description, “middle knuckle” generally refers to the proximal interphalangeal joint. For the purposes herein, the term “first knuckle” is interchangeable with the term “top knuckle”, and the term “second knuckle” is interchangeable with the term “middle knuckle”. As it is used in this description, “fingertip” generally refers to the tip segment, or portion thereof, but may also include the first knuckle and the middle segment, or portion thereof.

Various embodiments of the present disclosure provide fingertip, monopolar electrosurgical instruments for directing energy into tissue. Various embodiments of the present disclosure provide fingertip, bipolar electrosurgical instruments for directing energy into tissue. Embodiments may be suitable for utilization with hand-assisted, endoscopic and laparoscopic surgical procedures. Embodiments may be suitable for utilization in open surgical applications Embodiments may be implemented using electromagnetic radiation at microwave frequencies, RF frequencies or at other frequencies. Fingertip, monopolar and bipolar electrosurgical instruments, according to various embodiments, are designed and configured to operate between about 300 MHz and about 10 GHz.

Various embodiments of the presently disclosed fingertip, monopolar electrosurgical instrument including an energy applicator are suitable for microwave or RF ablation and for use to pre-coagulate tissue for microwave or RF ablation-assisted surgical resection.

A fingertip, monopolar electrosurgical instrument <b>10</b> according to an embodiment of the present disclosure is shown in <figref idref="DRAWINGS">FIG. 1</figref> and includes an electromagnetic energy delivery device or energy applicator <b>12</b>. <figref idref="DRAWINGS">FIG. 3</figref> shows the fingertip, monopolar electrosurgical instrument <b>10</b> coupled to the middle segment of a surgeon's finger.

Energy applicator <b>12</b> includes an elongated, electrically-conductive element <b>2</b> (also referred to herein as a “monopolar electrode”, or, simply, “electrode”) connected by a holder <b>3</b> via a transmission line <b>11</b> to a connector <b>17</b>, which may further operably connect the energy applicator <b>12</b> to an electrosurgical power generating source <b>28</b>. Holder <b>3</b> generally includes a housing body <b>8</b> and an attachment member <b>7</b>A configured to allow coupling of the holder <b>3</b> to a surgeon's finger.

In embodiments, the housing body <b>8</b> is adapted to provide an electrical connection between the electrode <b>2</b> and the transmission line <b>11</b>. In embodiments, the housing body <b>8</b> has a substantially cylindrical shape, and may be formed as a substantially hollow tubular body. Portions of the housing body <b>8</b> may include an electrically non-conductive material. Housing body <b>8</b> includes a distal end <b>15</b> and a proximal end <b>16</b>.

In some embodiments, the monopolar electrode <b>2</b> is configured to be removeably coupleable with the holder <b>3</b>, which allows for selective replacement of the electrode <b>2</b> (or the housing body <b>8</b> and the attachment member <b>7</b>A). In other embodiments, the electrode <b>2</b> is permanently affixed to the holder <b>3</b>, e.g., by a locking screw, a permanent adhesive, or other devices or processes to make a secure or permanent attachment.

Fingertip, monopolar electrosurgical instrument <b>10</b> may include a switch (not shown) configured to permit the user to selectively activate the energy applicator <b>12</b>. An actuator may additionally, or alternatively, be provided that is adapted to facilitate operative coupling with the electrosurgical power generating source <b>28</b>. The actuator may be any suitable actuator, such as, without limitation, a footswitch, a handswitch, an orally-activated switch (e.g., a bite-activated switch and/or a breath-actuated switch), and the like.

Fingertip, monopolar electrosurgical instrument <b>10</b> may be designed such that it is fully or partially disposable depending upon a particular purpose or to achieve a particular result. For example, the monopolar electrode <b>2</b> may be selectively and releasably engageable with the distal end <b>15</b> of the housing body <b>8</b>. In such case, the fingertip, monopolar electrosurgical instrument <b>10</b> would be considered “partially disposable” or “reposable”, e.g., a new or different monopolar electrode <b>2</b> selectively replaces the old monopolar electrode <b>2</b> as needed.

Monopolar electrode <b>2</b> may be formed of any suitable electrically-conductive material (e.g., metal such as stainless steel, aluminum, platinum, titanium, copper, gold or silver) of any suitable length. Monopolar electrode <b>2</b> may have a suitable length “L<b>1</b>” in a range from about 0.1 inches to about 3.0 inches. Electrode <b>2</b> may have a suitable width “W<b>1</b>” in a range from about 0.05 inches to about 0.50 inches. Electrode <b>2</b> includes a distal end <b>13</b> and a proximal end <b>14</b>, and may have a substantially cylindrical shape. The shape, size and number of electrode <b>2</b> may be varied from the configuration depicted in <figref idref="DRAWINGS">FIG. 1</figref>.

Located at the distal end <b>13</b> of the monopolar electrode <b>2</b> is an end portion <b>1</b>, which may terminate in a flat tip <b>23</b>. The end portion <b>1</b> may include other shapes, such as, for example, a tip <b>23</b> that is bulbous, rounded, square, hexagonal, or cylindroconical. Electrode <b>2</b> may take any number of shapes for a number of reasons, e.g., depending upon the type of surgical procedure and/or surgeon's preference.

Located at the proximal end <b>14</b> of the electrode <b>2</b> is a connector <b>4</b>. Connector <b>4</b> is adapted to mechanically and electrically couple the electrode <b>2</b> to the holder <b>3</b>. Connector <b>4</b> includes a connector rod <b>6</b> having a cylindrical, square or any other suitable configuration. Connector rod <b>6</b> may be releaseably engageable with an opening or socket <b>5</b> defined in the holder <b>3</b>. The connector rod <b>6</b> may have any suitable dimensions, and may include a threaded portion (not shown). It will be appreciated that, in an alternative embodiment, the holder <b>3</b> may be configured with a connector rod adapted to matingly engage with an opening or socket defined in the electrode <b>2</b>.

In embodiments, the housing body <b>8</b> includes an electrode-engagement portion <b>25</b> defining an interior opening <b>5</b>. The electrode-engagement portion <b>25</b>, or portion thereof, may be threaded for mating engagement with a threaded connector rod <b>6</b>. Electrode <b>2</b> may be electrically coupled to the electrode-engagement portion <b>25</b> by friction fit, solder or other suitable electrical connection.

Holder <b>3</b> includes an electrical current input terminal <b>20</b> disposed within the housing body <b>8</b>. Current input terminal <b>20</b> is configured to be operably coupled to the transmission line <b>11</b>. Current input terminal <b>20</b> may be disposed at any suitable position within the housing body. In an embodiment, the current input terminal <b>20</b> is disposed at the proximal end <b>16</b> of the holder <b>3</b>. In embodiments, the housing body <b>8</b> is configured to operably couple the monopolar electrode <b>2</b> to the current input terminal <b>20</b> for conveying energy to the monopolar electrode <b>2</b>. For example, the housing body <b>8</b> may include an electrically-conductive rod, wire or inner sleeve configured to electrically couple the electrode-engagement portion <b>25</b> with the current input terminal <b>20</b>.

In embodiments, the attachment member <b>7</b>A includes a ring member <b>9</b>, or a partial ring member (e.g., <b>90</b> shown in <figref idref="DRAWINGS">FIG. 2B</figref>), which has an interior aperture defined therein and configured to be located on the middle segment of a surgeon's finger. Ring member <b>9</b> may include an interior aperture defined therein and configured to be located on the tip segment, or the base segment, of a user's finger. Ring member <b>9</b> may have any suitable inner diameter to accommodate fingers of different thicknesses. In embodiments, the ring member <b>9</b> may have an inner diameter “D<b>1</b>” in a range from about 0.10 inches to about 2.0 inches, an outer diameter “D<b>2</b>” in a range from about 0.15 inches to about 2.05 inches, and a thickness “T<b>1</b>” in a range from about 0.05 inches to about 0.30 inches. Ring member <b>9</b> may have an adjustable inner diameter.

As cooperatively shown in <figref idref="DRAWINGS">FIGS. 1 and 2A</figref>, the attachment member <b>7</b>A may be integrally formed with the housing body <b>8</b>. Attachment member <b>7</b>A and the housing body <b>8</b> may be integrally formed by any suitable process, e.g., as part of a single molding process. Alternatively, the attachment member <b>7</b>A and the housing body <b>8</b> may be formed separately from each other, and coupled together. Mechanical fasteners, adhesives, and welding processes, e.g., laser welding, or other suitable joining method may be used to attach (or clip, connect, couple, fasten, secure, etc.) the attachment member <b>7</b>A to the housing body <b>8</b>.

Ring member <b>9</b> may include an electrically non-conductive material to prevent (or at least substantially prevent) the conduction of electrical current through the ring member <b>9</b> to the surgeon's finger. Ring member <b>9</b> may be formed of any suitable electrically-insulative material, including, but not limited to, ceramics, mica, polyethylene, polyethylene terephthalate, polyimide, polytetrafluoroethylene (PTFE) (e.g., Teflon®, manufactured by E.I. du Pont de Nemours and Company of Wilmington, Del., United States), metal oxides or other suitable insulator, and may be formed in any suitable manner. As cooperatively shown in <figref idref="DRAWINGS">FIGS. 2A and 2C</figref>, the inner peripheral surface <b>29</b> of the ring member <b>9</b> may be provided with a material <b>22</b>. Material <b>22</b> may be a soft-touch material to promote user comfort and/or reduce slip or spin of the ring member <b>9</b>, e.g., to prevent unwanted movement of the housing body <b>8</b> and the electrode <b>2</b> associated therewith.

An attachment member <b>71</b>D configured with a hinged ring member <b>91</b> according to an embodiment of the present disclosure is shown in <figref idref="DRAWINGS">FIGS. 2D and 2E</figref>. Hinged ring member <b>91</b> is generally adapted to allow for ease of attachment of the presently disclosed fingertip, monopolar electrosurgical instrument to the user's finger. Ring member <b>91</b> is shown in an open configuration in <figref idref="DRAWINGS">FIG. 2D</figref>. In <figref idref="DRAWINGS">FIG. 2E</figref>, the ring member <b>91</b> is shown in a closed configuration.

Ring member <b>91</b> includes a first ring-member portion <b>95</b> including a first end <b>92</b> and a second end <b>93</b>, and a second ring-member portion <b>96</b> including a first end <b>94</b> and a second end <b>97</b>. A hinge member <b>38</b> is disposed between and moveably couples the second end <b>93</b> of the first ring-member portion <b>95</b> and the second end <b>97</b> of the second ring-member portion <b>96</b>. First end <b>92</b> of the first ring-member portion <b>95</b> includes a first clasp element <b>71</b>, and the first end <b>94</b> of the second ring-member portion <b>96</b> includes a second clasp element <b>72</b> adapted to be releaseably engageable with the first clasp element <b>71</b> when the ring member <b>91</b> is placed in the closed configuration.

Electrode <b>2</b> dimensions, e.g., thickness “W<b>1</b>” and length “L<b>1</b>”, may be minimized, e.g., to facilitate a wide range of motion to allow for complex surgical articulation and/or to reduce trauma to the surgical site. In some embodiments, the energy applicator <b>12</b> includes a plurality of electrodes. The electrodes may have similar or different diameters, may extend to equal or different lengths, and may have a distal end with a tapered tip. In some embodiments, the one or more electrodes may be provided with a coolant chamber (not shown).

Fingertip, monopolar electrosurgical instrument <b>10</b> may include a temperature sensor (e.g., <b>31</b> shown in <figref idref="DRAWINGS">FIG. 3</figref>) configured to obtain temperature information associated with the electrode <b>2</b>. Temperature sensor <b>31</b> may be disposed within the holder housing <b>8</b>, and may be configured to contact the connector <b>4</b>, or portion thereof (e.g., connector rod <b>6</b>). The temperature sensor may be, for example, a thermocouple, a thermistor, or any other type of temperature sensing device capable of sending a signal indicative of a temperature of an electrode <b>2</b> portion to the electrosurgical power generating source <b>28</b> and/or to a processor unit (not shown). The processor unit may include any type of computing device, computational circuit, or any type of processor or processing circuit capable of executing a series of instructions that are stored in a memory associated with the processor unit.

Electrosurgical power generating source <b>28</b> may be any generator suitable for use with electrosurgical devices, and may be configured to provide various frequencies of electromagnetic energy. Examples of electrosurgical generators that may be suitable for use as a source of electrosurgical energy are commercially available under the trademarks FORCE EZ™, FORCE FX™, SURGISTAT™ II, and FORCE TRIAD™ offered by Covidien. Fingertip, monopolar electrosurgical instrument <b>10</b> may alternatively be configured as a wireless device.

In some embodiments, the electrosurgical power generating source <b>28</b> is configured to provide microwave energy at an operational frequency from about 300 MHz to about 2500 MHz. In other embodiments, the power generating source <b>28</b> is configured to provide microwave energy at an operational frequency from about 300 MHz to about 10 GHz. Electrosurgical power generating source <b>28</b> may be configured to provide various frequencies of electromagnetic energy.

In embodiments, the transmission line <b>11</b> may be formed from a suitable flexible, semi-rigid or rigid microwave conductive cable, and may connect directly to an electrosurgical power generating source <b>28</b>. Transmission line <b>11</b> may include an inner conductor, a dielectric material coaxially surrounding the inner conductor, and an outer conductor coaxially surrounding the dielectric material. Transmission line <b>11</b> may additionally, or alternatively, provide a conduit configured to provide coolant fluid from a coolant source (not shown) to the energy applicator <b>12</b>. In accordance herewith, temperatures at, or near the end portion <b>1</b> may be controlled by controlling the flow of coolant fluid through the electrode <b>2</b>. In this manner, the temperature of the surface area of the end portion <b>1</b> in contact with tissue is controllable.

In operation when using an RF power supply, electrical current spreads from the electrode <b>2</b>, or portion thereof, e.g., end portion <b>1</b>, to pass through the surrounding tissue causing the tissue to heat up. In embodiments, the electrode <b>2</b> carries an electrically-insulative coating (not shown) over a portion of its length for selectively preventing the flow of electrical current from the shaft of electrode <b>2</b> into surrounding tissue. The electrically-insulative coating may shield the intervening tissue from RF current, so that tissue along the length of the shaft is not substantially heated except by the heating effect from the exposed end portion <b>1</b>.

During a procedure, e.g., an ablation procedure, using the fingertip, monopolar electrosurgical instrument <b>10</b>, the energy applicator <b>12</b> is inserted into or placed adjacent to tissue and energy, such as microwave or RF energy, is supplied thereto. A clinician may pre-determine the length of time that energy is to be applied. Application duration may depend on a variety of factors such as energy applicator design, number of electrodes used simultaneously, tumor size and location, and whether the tumor was a secondary or primary cancer. The duration of energy application using the energy applicator <b>12</b> may depend on the progress of the heat distribution within the tissue area that is to be destroyed and/or the surrounding tissue.

During a procedure, a return electrode (not shown) may be positioned in contact with the skin of the patient or a surface of the organ. When the surgeon activates the presently disclosed energy applicator <b>12</b>, the return electrode may serve as a return current path for the current flowing from the power generating source <b>28</b> through the electrode <b>2</b>.

Poor fit of an attachment member may lead to reduced user comfort and/or increased difficulty in using the presently disclosed fingertip, monopolar electrosurgical instruments. <figref idref="DRAWINGS">FIG. 2B</figref> shows an attachment member <b>7</b>B of a fingertip, monopolar electrosurgical instrument in accordance with an embodiment of the present disclosure. Attachment member <b>7</b>B includes a partial ring member <b>90</b> and includes a cut-out portion “C” (shown by the dashed lines in <figref idref="DRAWINGS">FIG. 2B</figref>) defining a void in the ring member <b>90</b>, which may allow the ring member <b>90</b> to flex and expand in diameter, e.g., to accommodate fingers of different thicknesses, improve the ease of use and/or increase comfort of the wearer of the attachment member <b>7</b>B. In embodiments, the ring member <b>90</b> may have an inner diameter “D<b>3</b>” in a range from about 0.10 inches to about 2.0 inches, an outer diameter “D<b>4</b>” in a range from about 0.15 inches to about 2.05 inches, and a thickness “T<b>2</b>” in a range from about 0.05 inches to about 0.30 inches. Ring member <b>90</b> may be made, entirely or in part, from a flexible, electrically non-conductive material, e.g., polyurethane or other elastic plastic material.

<figref idref="DRAWINGS">FIG. 4</figref> shows a fingertip, monopolar electrosurgical instrument <b>410</b> coupled to a surgeon's finger according to an embodiment of the present disclosure that is similar to the fingertip, monopolar electrosurgical instrument <b>10</b> of <figref idref="DRAWINGS">FIGS. 1 and 3</figref>, except for the first and second attachment members <b>58</b> and <b>56</b>, respectively.

As cooperatively shown in <figref idref="DRAWINGS">FIGS. 4 and 5A</figref>, the first attachment member <b>58</b> is integrally formed with the housing body <b>8</b> and includes a first ring member <b>59</b> and a first neck portion <b>49</b>. First neck portion <b>49</b> is configured to provide a first gap “G₁” between the housing body <b>8</b> and the surgeon's finger. As cooperatively shown in <figref idref="DRAWINGS">FIGS. 4 and 5B</figref>, the second attachment member <b>56</b> is integrally formed with the housing body <b>8</b> and includes a second ring member <b>57</b> and a second neck portion <b>47</b>. Second neck portion <b>47</b> is configured to provide a second gap “G₂” between the housing body <b>8</b> and the surgeon's finger. First ring member <b>59</b> and the second ring member <b>57</b> may be formed of any suitable electrically-insulative material by any suitable process. The size and shape of the first and second ring members <b>59</b> and <b>57</b>, respectively, and the first and second neck portions <b>49</b> and <b>47</b>, respectively, may be varied from the configuration depicted in <figref idref="DRAWINGS">FIGS. 4 through 5B</figref>.

First neck portion <b>49</b> and the second neck portion <b>47</b> may have similar or different shapes, and may extend to equal or different lengths. In an embodiment the first and second neck portions <b>49</b> and <b>47</b>, respectively, have substantially similar shapes and are configured with substantially equal lengths, to substantially align a longitudinal axis (e.g., “A₂-A₂” shown in <figref idref="DRAWINGS">FIG. 4</figref>) of the electrode <b>2</b> with the central longitudinal axis (e.g., “A₅₉-A₅₉” shown in <figref idref="DRAWINGS">FIG. 4</figref>) of the first ring member<b>59</b> and the central longitudinal axis (e.g., “A₅₇-A₅₇” shown in <figref idref="DRAWINGS">FIG. 4</figref>) of the second ring member <b>57</b>. As shown in <figref idref="DRAWINGS">FIG. 4</figref>, in an embodiment where the first and second neck portions <b>49</b> and <b>47</b>, respectively, have substantially equal lengths, the first gap “G₁” may be approximately equal to the second gap “G₂” such that the electrode <b>2</b> is aligned substantially parallel to the surgeon's finger, or segment thereof. The first gap “G₁” and/or the second gap “G₂” may be selectively adjusted by varying one or more dimensions, e.g., length, of the first neck portion <b>49</b> and/or the second neck portion <b>47</b>, to permit angular adjustment of the electrode <b>2</b> with respect to the surgeon's finger, or particular segment(s) thereof.

<figref idref="DRAWINGS">FIG. 6</figref> shows a fingertip, monopolar electrosurgical instrument <b>610</b> according to an embodiment of the present disclosure that includes an energy applicator <b>612</b> and a holder <b>63</b>. <figref idref="DRAWINGS">FIG. 7</figref> shows the presently disclosed fingertip, monopolar electrosurgical instrument <b>610</b> coupled to a surgeon's finger.

Energy applicator <b>612</b> includes a monopolar electrode <b>62</b> connected by the holder <b>63</b> via a transmission line <b>11</b> to a connector <b>17</b>, which may further operably connect the energy applicator <b>612</b> to an electrosurgical power generating source <b>28</b>, e.g., a microwave or RF electrosurgical generator. As cooperatively shown in <figref idref="DRAWINGS">FIGS. 6 and 7</figref>, the holder <b>63</b> is configured to support the energy applicator <b>612</b> such that the electrode <b>62</b> extends longitudinally from the distal end of the surgeon's fingertip. Monopolar electrode <b>62</b> may be removeably coupleable with the holder <b>63</b>, and may be a standard blade electrode, ball electrode, needle electrode, spatula electrode, L-shape hook electrode, J-shape hook electrode, specialty electrode, or other suitable configuration. Monopolar electrode <b>62</b> may have a suitable length “L<b>2</b>” in a range from about 0.1 inches to about 3.0 inches. Electrode <b>62</b> may have a suitable width “W<b>2</b>” in a range from about 0.05 inches to about 0.5 inches. A connector <b>64</b> is located at the proximal end of the electrode <b>62</b>. Electrode <b>62</b> and the connector <b>64</b> are similar to the electrode <b>2</b> and the connector <b>4</b>, respectively, shown in <figref idref="DRAWINGS">FIG. 1</figref> and further description thereof is omitted in the interests of brevity.

Holder <b>63</b> includes a housing body <b>65</b>, a first attachment member <b>68</b> and a second attachment member <b>66</b>. Housing body <b>65</b> is adapted to provide an electrical connection between the electrode <b>62</b> and the transmission line <b>11</b>. First attachment member <b>68</b> includes a first ring member <b>69</b>, which has an interior aperture defined therein. In embodiments, the aperture is configured to be located on the distal segment of a surgeon's finger. Second attachment member <b>66</b> includes a second ring member <b>67</b>, which has an interior aperture configured to be located on the middle segment of a surgeon's finger. First and second ring members <b>69</b> and <b>67</b>, respectively, may be formed of any suitable electrically-insulative material. The size, shape and relative spacing of the first ring member <b>69</b> and the second ring member <b>67</b> may be varied from the configuration depicted in <figref idref="DRAWINGS">FIG. 6</figref>.

As cooperatively shown in <figref idref="DRAWINGS">FIGS. 6 and 7</figref>, the holder <b>63</b> is configured to support the energy applicator <b>612</b> such that the electrode <b>62</b> extends from the distal end of the surgeon's fingertip. As shown in <figref idref="DRAWINGS">FIG. 7</figref>, a portion of the housing body <b>65</b>, bridging between the first ring member <b>69</b> disposed on the distal side of the first knuckle and the second ring member <b>66</b> disposed on the proximal side of the first knuckle, spans across the first knuckle, which may provide a stabilizing influence on the surgeon's fingertip, which may enhance the surgeon's capability to point the monopolar electrode <b>62</b>.

<figref idref="DRAWINGS">FIG. 8</figref> shows a fingertip, monopolar electrosurgical instrument <b>800</b> according to an embodiment of the present disclosure that includes a fingertip sleeve <b>85</b>, a holder <b>83</b> coupled to the fingertip sleeve <b>85</b>, and an energy applicator <b>812</b> coupled to the holder<b>83</b>. Energy applicator <b>812</b> is similar to the energy applicator <b>12</b> shown in <figref idref="DRAWINGS">FIG. 1</figref> and further description thereof is omitted in the interests of brevity.

In embodiments, the fingertip sleeve <b>85</b> is configured to cover the tip segment and the first knuckle of the surgeon's finger, and may cover at least a portion of the middle segment. Fingertip sleeve <b>85</b> may be formed of a flexible, biocompatible material, e.g., one or more layers of a biocompatible, polymeric material.

Fingertip sleeve <b>85</b> generally includes a substantially tubular member having an open end and a closed end. The tubular member is adapted to receive a finger therein with the fingertip abutting the closed end. Fingertip sleeve <b>85</b> may be seamless. A releasable adhesive, or film layer having a high friction surface, may be distributed over at least a portion of the interior of the fingertip sleeve <b>85</b>, e.g., to inhibit slippage of the sleeve from the surgeon's fingertip during a procedure.

Holder <b>83</b> is similar to the holder <b>3</b> shown in <figref idref="DRAWINGS">FIG. 1</figref>, except for the attachment member <b>19</b>. In embodiments, the attachment member <b>19</b> may include one or more mechanical fasteners, e.g., a clip, for securely coupling the housing body <b>8</b> to the fingertip sleeve <b>25</b>. Suitable adhesives, either alone or in combination with one or more mechanical fasteners, may be used as the attachment member <b>19</b>. Attachment member <b>19</b> may be formed of suitable materials by any suitable process. The size and shape of the attachment member <b>19</b> may be varied from the configuration depicted in <figref idref="DRAWINGS">FIG. 8</figref>.

<figref idref="DRAWINGS">FIG. 9</figref> shows a fingertip, monopolar electrosurgical instrument <b>900</b> according to an embodiment of the present disclosure that is similar to the fingertip, monopolar electrosurgical instrument <b>800</b> shown in <figref idref="DRAWINGS">FIG. 8</figref>, except for the configuration of the finger sleeve <b>35</b>. Finger sleeve <b>35</b> is configured to cover the tip segment, first knuckle, second segment, and the second knuckle of the surgeon's finger, and may cover at least a portion of the third segment.

<figref idref="DRAWINGS">FIG. 10</figref> shows a fingertip, monopolar electrosurgical instrument <b>1000</b> according to an embodiment of the present disclosure that is similar to the fingertip, monopolar electrosurgical instrument <b>900</b> shown in <figref idref="DRAWINGS">FIG. 9</figref>, except for the configuration of the finger sleeve <b>45</b>. Finger sleeve <b>45</b> is configured to cover the surgeon's entire finger, and may have a substantially tubular shape. Finger sleeve <b>45</b> may be configured to have a shape substantially conforming to a shape of a finger, and may include a liner, e.g., to enhance wearer comfort. Finger sleeve <b>45</b> provides an increased surface area in contact with the surgeon's finger, e.g., in comparison to the finger sleeve <b>35</b> shown in <figref idref="DRAWINGS">FIG. 9</figref> and the fingertip sleeve <b>25</b> shown in <figref idref="DRAWINGS">FIG. 8</figref>, which may improve sleeve retention characteristics and/or provide enhanced insulative properties that help prevent the flow of electrical current from the electrode <b>2</b> into the surgeon's finger.

Fingertip sleeve <b>25</b>, finger sleeve <b>35</b> and finger sleeve <b>45</b>, and/or the holder <b>83</b> affixed thereto, may be discarded or recycled after a single use. Energy applicator <b>812</b> may be formed of stainless steel or other durable materials that are reusable and resterilizable.

<figref idref="DRAWINGS">FIG. 11</figref> shows a fingertip, monopolar electrosurgical instrument <b>1100</b> according to an embodiment of the present disclosure that is similar to the fingertip, monopolar electrosurgical instrument <b>1000</b> shown in <figref idref="DRAWINGS">FIG. 10</figref>, except for the surgical glove <b>55</b> that replaces the finger sleeve <b>45</b>. Surgical glove <b>55</b> generally includes a hollow member defining an open proximal end for receiving a hand. Surgical glove <b>55</b> may be a surgical-quality latex glove, and may be available in a range of sizes, e.g., 300 mm and 375 mm sizes or other suitable sizes. Surgical glove <b>55</b> may have a multi-layered configuration having high tactility and dexterity characteristics including an outer shell fabricated from relatively flexible and durable material. Surgical glove <b>55</b> may include an elastic cuff, a liner, e.g., a terry seamless knitted liner, and/or a textured palm and fingertips. A film layer having a high friction surface may be distributed over at least a portion of the interior of the surgical glove <b>55</b>, e.g., to minimize slippage and/or provide improved fluid barrier properties. Glove <b>55</b> may include an optional tightening device (not shown), such as fabric hook-and-loop (Velcro™) fasteners.

Fingertip, monopolar electrosurgical instrument <b>1100</b> includes the holder <b>83</b> and the energy applicator <b>812</b> coupled to the holder <b>83</b> of <figref idref="DRAWINGS">FIGS. 8 through 10</figref>. Holder <b>83</b> is coupled to the glove <b>25</b> by an attachment member (e.g., <b>19</b> shown in <figref idref="DRAWINGS">FIGS. 8 through 10</figref>). Suitable adhesives or other methods of attachment, either alone or in combination with one or more mechanical fasteners, may be used as the attachment member <b>19</b>. Examples of adhesives that may be suitable include urethane, epoxy, and rubbery adhesives. Other methods of attachment that may be suitably employed include laser welding, heat seal bonding, sonic welding and stitching.

Energy applicator <b>812</b> is electrically connected by the holder <b>83</b> via a transmission line <b>11</b> to a connector <b>17</b>, which may further operably connect the energy applicator <b>812</b> to an electrosurgical power generating source <b>16</b>. Electrosurgical power generating source <b>16</b> may be any generator suitable for use with electrosurgical devices, and may be configured to provide various frequencies of electromagnetic energy, e.g., a microwave or RF electrosurgical generator.

<figref idref="DRAWINGS">FIG. 12</figref> shows a fingertip, monopolar electrosurgical instrument <b>1200</b> coupled to a surgical glove according to an embodiment of the present disclosure that is similar to the fingertip, monopolar electrosurgical instrument <b>1100</b> of <figref idref="DRAWINGS">FIG. 11</figref>, except for the configuration of the transmission line <b>130</b>. Transmission line <b>130</b> generally includes a first transmission-line portion <b>131</b> (shown by the dashed lines in <figref idref="DRAWINGS">FIG. 12</figref>) electrically coupled to the holder <b>83</b>, and a second transmission-line portion <b>132</b> electrically coupled to the proximal end of the first transmission-line portion <b>131</b>. First transmission-line portion <b>131</b> may be embedded within the glove, e.g., disposed between layers of the glove material, or disposed, entirely or in part, beneath the glove, which may improve usability characteristics of the fingertip, monopolar electrosurgical instrument <b>1200</b>, e.g., during a procedure performed in confined spaces, where an exposed transmission line could potentially lead to tissue damage or otherwise impede surgical performance.

<figref idref="DRAWINGS">FIG. 13</figref> shows a patient “P” in a supine position on an operating table with his abdomen insufflated. Instrument access is provided by a first cannula <b>1301</b>, which may include a connection for introducing an insufflation gas, and a second cannula <b>1302</b>. A variety of instruments may be inserted through the first cannula <b>1301</b> and/or the second cannula <b>1302</b>, including surgical instruments and electrosurgical devices (e.g., “ESD” shown in <figref idref="DRAWINGS">FIGS. 13 and 16</figref>). As shown in <figref idref="DRAWINGS">FIG. 13</figref>, hand access is provided by an access port defined by a pressurized sleeve “S” sealingly attached to tissue surrounding an incision. During a procedure the surgeon inserts a hand through the pressurized sleeve “S” into the insufflated region and uses the hand for sensory perception and to assist the laparoscopic instruments directly, while observing the entire procedure on a monitor (not shown).

As shown in <figref idref="DRAWINGS">FIG. 13</figref>, during a hand-assisted surgical procedure, the fingertip, monopolar electrosurgical instrument <b>1200</b> of <figref idref="DRAWINGS">FIG. 12</figref> may be introduced via the pressurized sleeve “S” into the abdominal cavity. During certain procedures, the surgeon may activate the energy applicator <b>812</b> for directing energy into tissue. It is to be understood, however, that other fingertip, monopolar electrosurgical instrument embodiments (e.g., <b>10</b>, <b>410</b>, <b>610</b>, <b>800</b>, <b>900</b>, <b>1000</b> and <b>1100</b> shown in <figref idref="DRAWINGS">FIGS. 3</figref>, <b>4</b>, <b>7</b><b>8</b>, <b>9</b>, <b>10</b> and <b>11</b>, respectively) may also be used.

<figref idref="DRAWINGS">FIG. 14</figref> shows a fingertip, bipolar electrosurgical instrument <b>1400</b> according to an embodiment of the present disclosure that includes a first plate electrode <b>141</b> coupled via a first ring member to the surgeon's index finger (or other finger), and a second plate electrode <b>142</b> coupled via a second ring member to the surgeon's thumb. First plate electrode <b>141</b> and the second plate electrode <b>142</b> are generally configured to be used in an opposable relationship, e.g., to facilitate energy transfer and/or tissue grasping and releasing functions.

Using the fingertip, bipolar electrosurgical instrument <b>1400</b>, sealing pressure applied to a vessel “T” may be varied over a wide range by a user-applied force, e.g., by squeezing the vessel “T” between the first plate electrode <b>141</b> and the second plate electrode <b>142</b>. While the sealing pressure is applied, an electrical current can be run between the first plate electrode <b>141</b> and the second plate electrode <b>142</b> through the vessel “T” to coagulate, cauterize and/or seal the vessel “T”.

First plate electrode <b>141</b> and the second plate electrode <b>142</b>, according to various embodiments, are configured to enable the surgeon to achieve the proper or appropriate seal pressure. In embodiments, the first plate electrode <b>141</b> and the second plate electrode <b>142</b> are configured with one or more pair of opposed clip elements configured to limit the range of motion of the first plate electrode <b>141</b> and the second plate electrode <b>142</b> with respect to one another. First plate electrode <b>141</b> may include a first clip element <b>145</b> and a second clip element <b>143</b>, and the second plate electrode <b>142</b> may include a third clip element <b>146</b> and a fourth clip element <b>144</b>. First clip element <b>145</b> and the second clip element <b>143</b> may be disposed substantially adjacent to opposite ends of the first plate electrode <b>141</b>, e.g., to maximize the available surface area therebetween on the first plate electrode <b>141</b> for contact with the patient's “P” tissue. Third clip element <b>146</b> and the fourth clip element <b>144</b> may be disposed substantially adjacent to opposite ends of the second plate electrode <b>142</b>, e.g., to maximize the available surface area therebetween on the second plate electrode <b>142</b> for contact with the patient's “P” tissue.

In embodiments the first clip element <b>145</b> and the second clip element <b>143</b> may be configured to provide sensory and/or tactile feedback indicative of an appropriate sealing pressure has been achieved. First clip element <b>145</b> and the second clip element <b>143</b> may be configured to engage in a snap-fit manner with the third clip element <b>146</b> and the fourth clip element <b>144</b>, respectively, which may provide tactile sensory feedback indicative of the appropriate sealing pressure has been achieved.

In embodiments, the first plate electrode <b>141</b>, or portion thereof, and/or the second plate electrode <b>142</b>, or portion thereof, may be formed of a black or dark-colored material, or anti-reflection coated, to minimize unwanted reflections. In embodiments, the first plate electrode <b>141</b> and/or the second plate electrode <b>142</b> may be formed of a substantially transparent material, e.g., to minimize unwanted reflections and/or enhance visualization of tissue disposed between the sealing plates. First plate electrode <b>141</b> and the second plate electrode <b>142</b> may take a variety of shapes, e.g., tapered or curved, depending upon multiple factors, such as, for example, the patient's anatomy, the type of surgical procedure, and preference of the surgeon and/or the patient.

In embodiments, the first plate electrode <b>141</b> is coupled to a first attachment member <b>151</b>, and the second plate electrode <b>142</b> is coupled to a second attachment member <b>152</b>. First plate electrode <b>141</b> is connected by the first attachment member <b>151</b> via a first transmission line <b>161</b> to a connector <b>171</b>, which may further operably connect the first plate electrode <b>141</b> to an electrosurgical power generating source <b>18</b>, Electrosurgical power generating source <b>18</b> may be any generator suitable for use with electrosurgical devices, and may be configured to provide various frequencies of electromagnetic energy. Second plate electrode <b>142</b> is connected by the second attachment member <b>152</b> via a second transmission line <b>162</b> to a connector <b>172</b>, which may further operably connect the second plate electrode <b>142</b> to the electrosurgical power generating source <b>18</b>.

First attachment member <b>151</b> includes a first ring member <b>153</b> including an interior aperture defined therein and configured on the tip segment of a finger. First ring member <b>153</b> may have any suitable inner diameter to accommodate fingers of different thicknesses. First ring member <b>153</b> may include an electrically non-conductive material disposed on an inner peripheral surface <b>155</b> of the first ring member <b>153</b>. Second attachment member <b>152</b> includes a second ring member <b>154</b> including an interior aperture defined therein and configured on the tip segment of a finger. In embodiments, the second ring member <b>154</b> includes an electrically non-conductive material disposed on an inner peripheral surface <b>156</b> of the second ring member <b>154</b>.

<figref idref="DRAWINGS">FIG. 15</figref> shows a fingertip, bipolar electrosurgical instrument <b>1500</b> according to an embodiment of the present disclosure that includes a surgical glove <b>75</b>, a first electrode plate <b>141</b>, a second electrode plate <b>142</b>, a first connector member <b>1551</b>, and a second connector member <b>1552</b>. Surgical glove <b>75</b> generally includes a plurality of finger sheaths configured to cover the configured to cover the surgeon's fingers. Fingertip, bipolar electrosurgical instrument <b>1500</b> may include one or more pair of opposed clip elements (e.g., first, second, third and fourth clip elements <b>145</b>, <b>143</b>, <b>146</b> and <b>144</b>, respectively, shown in <figref idref="DRAWINGS">FIG. 14</figref>) configured to limit the range of motion of the first plate electrode <b>141</b> and the second plate electrode <b>142</b> with respect to one another. The clip elements may be configured to engage in a snap-fit manner to provide a tactile sensory feedback indicative of the appropriate sealing pressure has been achieved.

First electrode plate <b>141</b>, which is capable of applying bipolar energy into tissue “T”, is configured to be coupled to a first finger sheath of the surgical glove <b>75</b>. Second electrode plate, which is capable of applying bipolar energy into tissue “T”, is configured to be coupled to a second finger sheath of the surgical glove <b>75</b>. First connector member <b>1551</b>, which is associated with the first finger sheath, is electrically coupled via a transmission line <b>1567</b> to the first electrode plate <b>141</b>. In embodiments, the first connector member <b>1551</b> may include the first ring member <b>153</b> shown in <figref idref="DRAWINGS">FIG. 14</figref>, which may be embedded in the surgical glove <b>75</b>. Second connector member <b>1552</b>, which is associated with the second finger sheath, is electrically coupled via a transmission line <b>1568</b> to the second electrode plate <b>142</b>. In embodiments, the second connector member <b>1552</b> may include the second ring member <b>154</b> shown in <figref idref="DRAWINGS">FIG. 14</figref>, which may be embedded in the surgical glove <b>75</b>.

In embodiments, the surgical glove <b>75</b> includes a material having a high level of puncture and cut resistance, e.g., a weave or knit of a material such as Kevlar, nylon or fiberglass. Surgical glove <b>75</b> may additionally, or alternatively, be formed of a material including a nonporous membrane that is substantially impermeable to fluids, e.g., blood. Surgical glove <b>75</b> may be formed of a material having oxygen permeability of at least 100 barrers. Surgical glove <b>75</b> may be formed of an ultra-thick material to provide a more effective insulator, e.g., to give an appropriate level of protection to the user.

In embodiments, the surgical glove <b>75</b> may be formed of a material that hydrates slowly. A glove that has become hydrated may measure a lower electrical resistance than a non-hydrated glove. A surgical glove that hydrates slowly may offer added protection against electrical shock and undesired burns.

As shown in <figref idref="DRAWINGS">FIG. 15</figref>, at least a portion of the first and second electrode plates <b>141</b> and <b>142</b>, respectively, is disposed in contact with an outer surface of the surgical glove. First plate electrode <b>141</b> is connected by the first connector member <b>1551</b> via a transmission line <b>1561</b> to a connector <b>170</b>, which further operably connects the first plate electrode <b>141</b> to a first pole of an electrosurgical power generating source <b>18</b>, e.g., a microwave or RF electrosurgical generator. In embodiments, the first connector member <b>1551</b> and the transmission line <b>1561</b> are embedded in the surgical glove <b>75</b> (as indicated by dashed lines in <figref idref="DRAWINGS">FIG. 15</figref>). Second plate electrode <b>142</b> is connected by a second connector member <b>1552</b> via a transmission line <b>1562</b> to the connector <b>170</b>, which further operably connects the second plate electrode <b>142</b> to a second pole of the electrosurgical power generating source <b>18</b>. In embodiments, the second connector member <b>1552</b> and the second transmission line <b>1562</b> are embedded in the surgical glove <b>75</b> (as indicated by dashed lines in <figref idref="DRAWINGS">FIG. 15</figref>).

Proximal ends of the transmission lines <b>1561</b> and <b>1562</b> may be coupled to a junction member <b>1590</b>. Junction member <b>1590</b> may be configured to be detachably coupleable to a transmission line <b>111</b>, which may further operably connect the transmission lines <b>1561</b> and <b>1562</b> to a connector <b>170</b>. Junction member <b>1590</b>, or portion thereof, may be embedded or otherwise attached to the surgical glove <b>75</b>.

<figref idref="DRAWINGS">FIG. 16</figref> shows a patient “P” in a supine position on an operating table with his/her abdomen insufflated. Instrument access is provided by a first cannula <b>1301</b>, which may include a connection for introducing an insufflation gas, and a second cannula <b>1302</b>. A variety of instruments may be inserted through the first cannula <b>1301</b> and/or the second cannula <b>1302</b>, e.g., electrosurgical device “ESD”. As shown in <figref idref="DRAWINGS">FIG. 16</figref>, hand access is provided by a pressurized sleeve “S”. During a procedure the surgeon inserts a hand through the pressurized sleeve “S” into the insufflated region and uses the hand for sensory perception and to assist the laparoscopic instruments directly, while observing the entire procedure on a monitor (not shown).

As shown in <figref idref="DRAWINGS">FIG. 16</figref>, during a hand-assisted surgical procedure, the fingertip, bipolar electrosurgical instrument <b>1500</b> of <figref idref="DRAWINGS">FIG. 15</figref> may be introduced via the pressurized sleeve “S” into the abdominal cavity for directing energy into tissue, e.g., to effect vessel sealing, at times during the procedure. It is to be understood, however, that other fingertip, bipolar electrosurgical instrument embodiments (e.g., <b>1400</b> shown in <figref idref="DRAWINGS">FIG. 14</figref>) may also be used.

<figref idref="DRAWINGS">FIG. 17</figref> shows a sealing member <b>1700</b> according to an embodiment of the present disclosure that includes a plate electrode <b>1741</b>. Sealing member <b>1700</b> generally includes a ring member <b>1753</b> and a seal plate assembly <b>1752</b> coupled thereto. Ring member <b>1753</b> is similar to the ring member <b>155</b> of shown in <figref idref="DRAWINGS">FIG. 14</figref> and further description thereof is omitted in the interests of brevity.

Seal plate assembly <b>1752</b> includes a plate electrode <b>1741</b> and a strain gage or load cell <b>1775</b> (herein referred to as a strain gage). Plate electrode <b>1741</b> is configured to be operably coupled to an electrosurgical power generating source <b>18</b>. In some embodiments, the plate electrode <b>1741</b> is electrically coupled to the electrosurgical power generating source <b>18</b> via a wire <b>1761</b>. Wire <b>1761</b> is electrically coupled to the plate electrode <b>1741</b> by any suitable manner of electrical connection, e.g., soldering, welding, or laser welding.

Strain gage <b>1775</b> is disposed generally parallel to the plate electrode <b>1741</b> with a first electrically-insulative material <b>1732</b> disposed therebetween. Strain gage <b>1775</b> may be configured to be operably coupled to a processor unit (not shown) via a wire <b>1765</b>. Wire <b>1765</b> (and/or wire <b>1761</b>) may be integrated into a multi-wire cable assembly <b>1767</b>. Processor unit may include any type of computing device, computational circuit, or any type of processor or processing circuit capable of executing a series of instructions that are stored in a memory (not shown) associated with the processor unit, which may be in communication with a display device (not shown) , such as without limitation a flat panel graphic LCD (liquid crystal display), and/or a visual signal indicator <b>1800</b>, which is shown in more detail in <figref idref="DRAWINGS">FIG. 18</figref>. Strain gage <b>1775</b> may be a ¼, ½, full bridge strain gage or any combination to obtain the desired tolerance. In some embodiments, the force range for the strain gage <b>1775</b> may be from about 5 psi (pounds per square inch) to about 300 psi. A second electrically-insulative material <b>1736</b> may be disposed about the strain gage <b>1775</b>, and may be configured to enclose the first electrically-insulative material <b>1732</b>. Strain gage <b>1775</b> may be used in one or more sealing members <b>1700</b> of a fingertip, bipolar electrosurgical instrument in accordance with the present disclosure. For example, the use of two plate electrodes <b>1741</b> each configured with the strain gage <b>1775</b> may allow for increased accuracy of the force measurement.

Fingertip, bipolar electrosurgical instruments in accordance with the present disclosure may include two sealing members <b>1700</b>. In some embodiments, the fingertip, bipolar electrosurgical instrument may be configured to signal the user (e.g., via visual signal indicator <b>1800</b> shown in <figref idref="DRAWINGS">FIG. 18</figref>) to activate the plate electrodes <b>1741</b>, or automatically activate the plate electrodes <b>1741</b>, when the appropriate sealing pressure is reached between the plate electrodes <b>1741</b> of the two sealing members <b>1700</b>. Fingertip, bipolar electrosurgical instruments in accordance with the present disclosure may include two sealing members <b>1700</b> embedded in a glove, e.g., similar to the fingertip, bipolar electrosurgical instrument <b>1500</b> shown in <figref idref="DRAWINGS">FIG. 15</figref>.

<figref idref="DRAWINGS">FIG. 18</figref> is a schematic illustration of a visual signal indicator <b>1800</b> capable of emitting light signals indicatory of a sealing pressure range according to an embodiment of the present disclosure. In some embodiments, the visual signal indicator <b>1800</b> includes one or more light-emitting devices <b>1802</b>, e.g., light-emitting diodes (LEDS), capable of emitting light signals indicatory of a sealing pressure range. Visual signal indicator <b>1800</b> may be configured with one light-emitting device <b>1805</b> (outlined in bold in <figref idref="DRAWINGS">FIG. 18</figref>) indicatory of an “optimal sealing pressure” condition when lighted, or flashing. In some embodiments, the visual signal indicator <b>1800</b> may be a bar graph displayed on a display device (not shown).

Various embodiments of the presently disclosed fingertip, monopolar and bipolar electrosurgical instruments may be suitable for use in a variety of procedures and operations. The above-described electrosurgical instrument embodiments may be suitable for utilization with hand-assisted, endoscopic and laparoscopic surgical procedures. The above-described electrosurgical instrument embodiments may be suitable for utilization in open surgical applications.

The above-described electrosurgical instruments may potentially reduce procedure time. Having the presently disclosed electrosurgical instruments at the surgical site may reduce the number of times the surgeon's hand is extracted and re-inserted through an access port for performing surgical procedures within an insufflated body cavity and/or minimize the need for instrument removal and re-insertion to change instruments in the laparoscopic ports. The above-described electrosurgical instruments may enhance the suitability of laparoscopy for complex abdominal surgery.

The above-described fingertip, monopolar electrosurgical instruments may offer the ability to perform more complex operations more safely by allowing tactile sensory feedback and depth perception. Various embodiments of the presently disclosed fingertip, monopolar electrosurgical instruments are capable of directing energy into tissue, and may be suitable for a variety of procedures, e.g., ablation procedures.

Various embodiments of the presently disclosed fingertip, bipolar electrosurgical instruments are capable of directing energy into tissue, and may be useful for a variety of operations, e.g., vessel sealing, tissue grasping and tissue cutting, coagulating, cauterizing and ablating, in open and laparoscopic surgical applications. Fingertip, bipolar electrosurgical instruments capable of vessel sealing during a HALS procedure may improve the reaction time to stop bleeding.

Although embodiments have been described in detail with reference to the accompanying drawings for the purpose of illustration and description, it is to be understood that the inventive processes and apparatus are not to be construed as limited thereby. It will be apparent to those of ordinary skill in the art that various modifications to the foregoing embodiments may be made without departing from the scope of the disclosure.